Does Medicaid Cover Plan B Emergency Contraceptive?

In this article...
  • Does Medicaid cover Plan B? The Plan B emergency contraceptive pill exists in a complex legal environment. Find out how your Medicaid coverage might pay for it.

Plan B is an emergency contraceptive pill that can prevent a pregnancy in the event of a mishap or lapse with other birth control. A single dose of Plan B, which is available as a low-cost generic, usually costs between $40 and $50. Medicaid benefits sometimes pay for Plan B, as do many other forms of private insurance.

Does Medicaid Cover Plan B?

At least one form of emergency contraceptive is covered by Medicaid in 47 states and the District of Columbia. This is often Plan B, which is available over the counter from pharmacies, but in some states, Medicaid only pays for a prescription pill. Three states do not offer any kind of Plan B coverage, regardless of whether a doctor prescribes it.

What Is Plan B?

Plan B is a brand name for a single-use, high-dose version of levonorgestrel, the active ingredient in many oral birth control pills. Using a higher-than-normal dose, Plan B triggers hormone changes in a woman's body that prevents the release of an egg during ovulation. The drug is effective if it is taken prior to the release of an egg, but it has no perceptible effect once an egg has already been released. Contrary to some media coverage, Plan B is not an "abortion pill" because it seems to have no effect on either fertilized eggs or implanted embryos. 

When Is Plan B Prescribed?

The most common use of Plan B is as an emergency measure taken after a woman's regular birth control has failed. This can be for any reason. Plan B is often taken after a condom breaks, after an impulsive and unprotected act of sex or in the emergency room as a preventative measure after a sexual assault. Because Plan B's effectiveness increases the earlier it is taken, doctors often advise women to buy a dose of Plan B and have it in reserve in case they need it on short notice.

Plan B is widely available over the counter in most states. Adults of both sexes can usually buy a single dose of Plan B directly from the pharmacy counter without any prescription or doctor's involvement. Girls aged 17 and under generally need to see a doctor to get a prescription before the pharmacy can provide Plan B for them. Boys aged 17 and under generally can't buy Plan B.

Can You Get Plan B for Free Without Medicaid?

The price of Plan B is close to $40 or $50 in nearly every state. If you live in a state where Medicaid doesn't cover Plan B, you might still have options for getting the pill either for a reduced price or for free. Many private health insurance policies have some provision for emergency contraceptives. People with qualifying low incomes may be able to get the medication from either Planned Parenthood or a charitable medical clinic. 

Does NYS Medicaid Cover Plan B?

NYS Medicaid pays for Plan B for participating residents of the state. Normally, the New York Medicaid program only pays for medications that have been prescribed by a doctor, but since 2007, the program has made an exception for Plan B through qualifying pharmacies. Some beneficiaries in the state of New York have a share of cost requirement that has to be paid before Plan B coverage kicks in. 

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